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How Can A Painful Scar On The Anal Region Be Treated?
Question: Hello Doctor,
wanted to inform you that i took a second opinion from a XXXXXXX surgeon at XXXXXXX Asia. He also said that the healing is 100% complete and the scar is also fully healed and soft. He and the surgeon who did my surgery have both advised me to get a manometry study done to check the pressure.
I am still very much in pain and 100% sure that it is the skin that has formed after the wound closed is troubling me. Be it a scar or bands of scar tissue.
I am feeling stinging pain and soreness, although there is some improvement in swelling/hardness.
Please confirm if i should get the manometry done or should wait for maybe 1-2 months more, as i am pretty confident that i am having pain in the scar/scar tissue.
Also please share what you feel as to will this problem of mine will be resolved as the time passes and if it doesn't is there any cure for my problem or not.
wanted to inform you that i took a second opinion from a XXXXXXX surgeon at XXXXXXX Asia. He also said that the healing is 100% complete and the scar is also fully healed and soft. He and the surgeon who did my surgery have both advised me to get a manometry study done to check the pressure.
I am still very much in pain and 100% sure that it is the skin that has formed after the wound closed is troubling me. Be it a scar or bands of scar tissue.
I am feeling stinging pain and soreness, although there is some improvement in swelling/hardness.
Please confirm if i should get the manometry done or should wait for maybe 1-2 months more, as i am pretty confident that i am having pain in the scar/scar tissue.
Also please share what you feel as to will this problem of mine will be resolved as the time passes and if it doesn't is there any cure for my problem or not.
Brief Answer:
Please get Manometry done asap - helps in ruling out
Detailed Answer:
Hi.
Thanks for your the review.
Noted the second opinion and all the concerns you mentioned.
To recapitulate:
The finger pointed in the last photo was at 12 O'clock position and the scar at 3 O'clock position. Hence does not look to be directly related to the scar.
Since you must have been examined many a times with per-rectal examination and proctoscopy, fissure-in-ano is difficult to miss.
Please give me some additional information:
Is there any pain on per-rectal examination and/or ano-proctoscopy examination?
Does the pain increase during or after passing stool?
Any relationship with the stress and/or anxiety?
Is the stool normal?
Any particular foods or beverages or any other factors that instigate or enhance your pains?
Any complaints related to genito-urinary system? Like pain deep within the rectum like one gets in prostatitis, frequency or painful urination?
The effectiveness of Neurogaba M 75, Other medications we discussed if you have tried them like Deflazacort?
Doing Manometry studies will help to confirm or rule out any problems related to the present complaints. Please go ahead with it.
I would also advise Ultrasonography of the local area and that of abdomen for uro-genital system and prostate in particular to rule out pains related to it
Please get Manometry done asap - helps in ruling out
Detailed Answer:
Hi.
Thanks for your the review.
Noted the second opinion and all the concerns you mentioned.
To recapitulate:
The finger pointed in the last photo was at 12 O'clock position and the scar at 3 O'clock position. Hence does not look to be directly related to the scar.
Since you must have been examined many a times with per-rectal examination and proctoscopy, fissure-in-ano is difficult to miss.
Please give me some additional information:
Is there any pain on per-rectal examination and/or ano-proctoscopy examination?
Does the pain increase during or after passing stool?
Any relationship with the stress and/or anxiety?
Is the stool normal?
Any particular foods or beverages or any other factors that instigate or enhance your pains?
Any complaints related to genito-urinary system? Like pain deep within the rectum like one gets in prostatitis, frequency or painful urination?
The effectiveness of Neurogaba M 75, Other medications we discussed if you have tried them like Deflazacort?
Doing Manometry studies will help to confirm or rule out any problems related to the present complaints. Please go ahead with it.
I would also advise Ultrasonography of the local area and that of abdomen for uro-genital system and prostate in particular to rule out pains related to it
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Doctor,
Please find attached another pic in which i am pointing towards the pain point by my finger.
No there is no pain on ano proctoscopy.
When i wake up i am 100% ok.
Pain starts when i first pass stool and increases as the day progresses.
I cannot establish any relation with stress , but pain increases due to exhertion.
Stool is normal.
No foods or beverages increases pain.
No pain deep within the rectum, no painful urination.
I have not tried deflazacort, i am taking Neugaba and other medicines like lycored, revital u suggested.
I am 100% sure that i feel pain on the area where new skin has formed. I can also feel a band of scar tissue which is slightly raised at the exact point where there was external opening of my fistula.
Sometimes i also feel spasm / throbbing at the same point.
Please tell doctor according to you if it is the scar tissue which is troubling me. And does it really take this much time to heal. I have read at many sites that scar tissue starts to soften /fade after 1 year to 18 months.
And if it really is the scar tissue will it soften if i wait for 1 year to 18 months.
Sometimes i feel to get a kenalog injection at the point where i feel band of scar tissue.
I am in a real dilemma.
Please suggest if i should wait and watch or go ahead with the tests.
Thanks for you support
Regards
.
Please find attached another pic in which i am pointing towards the pain point by my finger.
No there is no pain on ano proctoscopy.
When i wake up i am 100% ok.
Pain starts when i first pass stool and increases as the day progresses.
I cannot establish any relation with stress , but pain increases due to exhertion.
Stool is normal.
No foods or beverages increases pain.
No pain deep within the rectum, no painful urination.
I have not tried deflazacort, i am taking Neugaba and other medicines like lycored, revital u suggested.
I am 100% sure that i feel pain on the area where new skin has formed. I can also feel a band of scar tissue which is slightly raised at the exact point where there was external opening of my fistula.
Sometimes i also feel spasm / throbbing at the same point.
Please tell doctor according to you if it is the scar tissue which is troubling me. And does it really take this much time to heal. I have read at many sites that scar tissue starts to soften /fade after 1 year to 18 months.
And if it really is the scar tissue will it soften if i wait for 1 year to 18 months.
Sometimes i feel to get a kenalog injection at the point where i feel band of scar tissue.
I am in a real dilemma.
Please suggest if i should wait and watch or go ahead with the tests.
Thanks for you support
Regards
.
Brief Answer:
MRI of the affected area may help.
Detailed Answer:
Hi.
Thanks for your elucidate feedback and fresh picture.
Noted all the points you have mentioned.
100% ok on getting up, no pain on ano-proctoscopy indicate the possibility of psychological overlay, may be anxiety as the pain starts when you first pass stool and increases as the day progresses.
Feeling spasm and throbbing sometimes again indicate towards the same.
This can be sort of ano-proctalgia that is mostly related to the spasms you get on passing the stool, the muscles getting into spasm due to fear of the previous experiences and this happens at the sub-conscious mind, the fear that something may happen instigates the vicious cycle of spasm > pain > causing more spasm > more pain - this way increases as the day passes.
Pregabalin may have helped you a bit.
You may please discuss this point too with your Doctor and add on an anxiolytic to have better results.
As we have discussed an interacted in previous discussions, the scar is at 3 O'clock and the pain is at 10 O'clock position. Hence less like to be due to anything in the scar; painful and tender scar would occur even on getting up early in the morning, before passing the stool.
This does not look to be due to scar problem directly. Scar usually starts maturing and matured by 9 months. If there is hypertrophy there would be enlargement of the scar tissue.
Kelloid is a thickened scar tissue with itching, irregular surface of the scar, tenderness on pressure; that you do not have.
Continue the Sitz bath in a tub with warm water.
Discuss and get additional treatment as just discussed.
Continue rest of the medicines as before.
Since all the patients get alright, you too will get symptom-free.
As also discussed in the past, MRI of the affected area can be of help to rule out or confirm if there is anything locally where the pain is present after discussing with the Radiologist too
I hope this answer helps you, please feel free to discuss and ask relevant further questions if you feel that there is a gap of communication.
MRI of the affected area may help.
Detailed Answer:
Hi.
Thanks for your elucidate feedback and fresh picture.
Noted all the points you have mentioned.
100% ok on getting up, no pain on ano-proctoscopy indicate the possibility of psychological overlay, may be anxiety as the pain starts when you first pass stool and increases as the day progresses.
Feeling spasm and throbbing sometimes again indicate towards the same.
This can be sort of ano-proctalgia that is mostly related to the spasms you get on passing the stool, the muscles getting into spasm due to fear of the previous experiences and this happens at the sub-conscious mind, the fear that something may happen instigates the vicious cycle of spasm > pain > causing more spasm > more pain - this way increases as the day passes.
Pregabalin may have helped you a bit.
You may please discuss this point too with your Doctor and add on an anxiolytic to have better results.
As we have discussed an interacted in previous discussions, the scar is at 3 O'clock and the pain is at 10 O'clock position. Hence less like to be due to anything in the scar; painful and tender scar would occur even on getting up early in the morning, before passing the stool.
This does not look to be due to scar problem directly. Scar usually starts maturing and matured by 9 months. If there is hypertrophy there would be enlargement of the scar tissue.
Kelloid is a thickened scar tissue with itching, irregular surface of the scar, tenderness on pressure; that you do not have.
Continue the Sitz bath in a tub with warm water.
Discuss and get additional treatment as just discussed.
Continue rest of the medicines as before.
Since all the patients get alright, you too will get symptom-free.
As also discussed in the past, MRI of the affected area can be of help to rule out or confirm if there is anything locally where the pain is present after discussing with the Radiologist too
I hope this answer helps you, please feel free to discuss and ask relevant further questions if you feel that there is a gap of communication.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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